Freedom Blue PPO Plan 2021 Provider Directory

Freedom Blue PPO Plan 2021 Provider Directory

This directory provides a list of Freedom Blue PPO's network providers.

This directory is for the following counties in Central and Northeastern Pennsylvania: Adams, Berks, Bradford, Carbon, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York.

Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most up-to-date information about Freedom Blue PPO's network providers in your area, you can visit highmarkblueshield. com/medicare or call our Customer Service Department at 1-800-550-8722, Monday through Sunday, 8:00 a.m. to 8:00 p.m. TTY users should call 711.

To access Freedom Blue PPO's online provider directory, you can visit medicare. For any questions about the information contained in this directory (hardcopy or online), please call our Customer Service Department at 1-800-550-8722, Monday through Sunday, 8:00 a.m. to 8:00 p.m. TTY users should call 711.

This document may be available in alternate formats. Please call our Customer Service Department at the numbers listed above.

Highmark Senior Health Company is a PPO plan with a Medicare contract. Enrollment in Highmark Senior Health Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Senior Health Company. Highmark Blue Shield provides certain administrative communications for these companies.

This directory is current as of November 8, 2021.

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Table of Contents

Please click the link on each section to go to that page.

Section 1 - Introduction ....................................................................................................................... 4 What is the service area for Freedom Blue PPO? ..................................................7 How do you find Freedom Blue PPO providers that service your area?........8

Section 2 ? List of Network Providers ............................................................................................. 9 Primary Care Providers Index ....................................................................................13 Primary Care Providers ................................................................................................41 Language Index for Providers .................................................................................151 Specialist Physicians Index .......................................................................................159 Specialist Physicians ...................................................................................................203 Routine Hearing Care Providers .............................................................................577 Routine Vision Care Providers .................................................................................587 Hospitals, Home Health, SNFs and Ambulatory Surgical Centers..............695 Durable Medical Equipment Providers ...............................................................729 Dental Providers ..........................................................................................................741 Outpatient Mental Health Providers ...................................................................797 Chain Pharmacies .......................................................................................................877 Pharmacies ....................................................................................................................881 Out-of-State Pharmacies ..........................................................................................901

Section 1 ? Introduction

This directory provides a list of Freedom Blue PPO's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).

From time to time, contract status may change, meaning that a provider's listing in the directory does not guarantee that the provider is still in the network or accepting new patients. If you regularly see a network provider, and that provider's contract is terminated, Freedom Blue PPO will notify you in writing regarding your options 30 calendar days before the effective date of the termination.

The "network providers" listed in this directory have agreed to provide you with your health care/ vision/dental coverage. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers.

Freedom Blue PPO members may go to any health care provider of their choice--either in or out of the Highmark Medicare Advantage PPO Network--as long as the provider has not opted out of the Medicare program. If you get a health care service from a network provider, this is known as an "in-network" service. Eligible in-network services are covered in full except for small copayments or coinsurance for certain services. A health care service you get from a non-network provider is known as an "out-of-network" service. You may use non-network providers to get your covered services, but your out-of-pocket costs may be higher than if you use our network providers. There are special rules for out-of-network services. Certain services that we offer are not covered out-of-network. Also, you do not need to get a referral or prior authorization when you get out-of-network services from non-network providers. However, before getting an out-of-network service, you may want to check with your plan to see if the services you are getting are covered by your plan and are medically necessary.

Out-of-network/non-contracted providers are under no obligation to treat Freedom Blue PPO members, except in emergency situations. For a decision about whether we will cover an outof-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services.

Before you pay any bills you receive from any provider either in or out of the Highmark Medicare Advantage Network, call the Customer Service Department for instructions, Monday through Sunday between 8:00 a.m. and 8:00 p.m. at 1-800-550-8722. TTY users should call 711. Eligible services will be paid by Freedom Blue PPO. You should never pay any nonnetwork provider more than what the provider is allowed by Medicare. Ask the non-network provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If you get a bill for the services, you can send the bill to us for payment. We will pay your non-network provider for our share of the bill and will let you know what, if anything, you must pay. If you pay for any emergency or urgent care you receive from providers who are not part of the network, request reimbursement by submitting the receipt(s) for care you received to the address listed below:

Highmark Medicare Advantage Customer Service P.O. Box 1068, Pittsburgh, PA 15230

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For emergency care, including post stabilization care, and urgently needed care, your out-ofpocket costs will be the same both in and out-of-network. For cost sharing information see your Evidence of Coverage (EOC).

Freedom Blue PPO also pays for medically necessary, non-emergency services needed to ensure that the member remains stabilized, from the time the treating hospital requests authorization until the member is discharged from the hospital, placed in the care of a Highmark Medicare Advantage Network doctor, or the treating doctor and Highmark agree to another arrangement.

Freedom Blue PPO also pays for treatment members need for illnesses or injuries which are not emergencies, but which could cause serious problems or endanger your health if treatment is delayed. You are covered for such urgent medical needs while you are within or outside the service area. While out of the area, get the care you need from any provider of your choice. If the Highmark Medicare Advantage Network is not available or accessible due to an unusual event, you are also covered for urgent care you receive from any provider.

Freedom Blue PPO pays for emergency care members receive within the service area and while traveling outside of the service area, for both inpatient and outpatient services that are furnished by a qualified provider and needed to evaluate or stabilize an emergency medical condition. When you need emergency care, go directly to a hospital emergency room or call 911 or your local emergency number. Show the hospital your Membership (ID) Card. In an emergency you never need to contact any plan provider for authorization. However, as soon as possible, you or someone else should contact your preferred provider or PCP, if you have one, so that he/she may provide follow-up care.

Freedom Blue PPO members are encouraged to choose a preferred provider/primary care provider (PCP), but it is not required. You may select any provider from the Preferred Providers/ Primary Care Provider section of this directory as your preferred provider.

All Network physicians are carefully screened and credentialed to meet strict quality standards. Before you contact any provider in this directory, please read your Evidence of Coverage (EOC) for detailed information about your specific plan's benefits, limitations, copayments and coinsurance, and how to receive care.

Highmark Blue Shield understands the importance of helping our members find Network health care providers who are accessible to people with physical disabilities and who can communicate with people who have sensory disabilities. If you'd like to know if a particular health care provider can accommodate these special needs, please contact the provider's office directly. If you prefer, call the Customer Service Department at 1-800-550-8722, Monday through Sunday between 8:00 a.m. and 8:00 p.m. TTY users should call 711, or visit our Website at medicare and click on "Find a Provider" in the footer of the page.

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